A modified anal eversion technique for colorectal anastomosis in laparoscopic rectal cancer surgery

Aims: This study presents a modified colorectal anastomosis method that consists of multi-task use of a circular stapler and anal eversion to perform a safer anastomosis. We aimed to describe the anorectal eversion and anastomosis techniques in detail and compare the results of the modified technique with those of the standard laparoscopic surgical technique. Methods: This retrospective study was conducted with fifty-five patients who underwent laparoscopic TME for middle and distal rectal cancer between 2016-2022. The patients were divided into two groups: those who underwent standard laparoscopic transabdominal surgery and those who underwent anorectal eversion (Modified ASET Method). The baseline features of the patients and the distribution of surgical outcomes between the two groups were statistically compared. Results: The Modified ASET group consisted of twenty-one patients. The morbidity rate associated with this procedure was 14.2%. CRM was positive in 9.5% of patients, and a safe distal surgical margin was achieved in all patients. The local recurrence rate is 4.7%. No statistically significant difference was observed between the Modified ASET and standard TME groups in terms of oncological outcomes (p = 0.828). Conclusion: Anorectal stump eversion and extra-abdominal transection-based modified colorectal anastomosis are reliable approaches that provide satisfactory surgical outcomes.